When Hannah Partos needed a stem cell transplant, she discovered just how lucky she was to be saved by an anonymous “chunky lad”. Data consistently shows that men sign up as organ and blood donors less than women do and the NHS Blood and Transplant service says it needs to recruit 25,000 new male donors. So why is the gender imbalance in donation a problem and how can the issue be tackled?
Why are women more willing donors than men?
I wrote my first story in a pink Barbie notepad, with the painstaking handwriting and felt-tip illustrations of a six-year-old. A princess was drowning at sea. A prince tried to save her but was too scared of the rising waves; a female dragon rescued her and they lived happily ever after.
I liked fairy tales as a child, but I was brought up to be dismissive of the classic young-male-hero-saves-damsel-in-distress narrative. I could never have imagined that, in the story of my own life, it would be a young male hero who rescued me from impending death. At 22, I was diagnosed with an aggressive form of blood cancer and told that a transplant of healthy stem cells was my only hope of survival. An anonymous “chunky lad” – as one doctor called him – just a year older than me was found through the national bone marrow register, and he went on to donate six million of his stem cells.
I was lucky: research shows that younger stem cell donors lead to better survival outcomes for patients, and I was told at the time that men make ideal donors, as they are generally larger than women and produce more cells. Unlike young women, they are more likely to be available to donate, as women cannot do so during pregnancy, or for at least six months after childbirth.
But although young male donors are the top choice for clinicians, men aged 16–30 only make up 18 per cent of the UK’s stem cell registers. Women dominate the registers overall, accounting for 60 per cent of potential stem cell donors.
And it’s not just stem cells that women appear to be more willing to donate. Two-thirds of all new blood donors are female, and there are over 100,000 more female blood donors than men, according to NHS Blood and Transplant (NHSBT). Women also make up the majority of the organ donor register, albeit by a narrower margin – 53 per cent is female (46 per cent male and less than 1 per cent unknown). In living kidney donation, women accounted for an average of 52.5 per cent of donors in the last six years.
So what’s going on? Are women more altruistic than men? Or are men really wimps, as Professor Lorna Marson, a consultant transplant surgeon and president of the British Transplantation Society, asked in a co-authored editorial commenting on gender disparities in live kidney donation.
There is no simple answer. Finding out why is a puzzle for experts and policymakers, nowhere more so than when it comes to blood donation. As the number of men giving blood has fallen by almost 25 percent since 2013/2014, according to the latest data from 2018/2019, NHSBT urgently needs to recruit more of them to supply the national blood stocks – especially because they tend to make ideal donors. For one thing, they can donate blood more frequently than women (every 12 weeks compared with every 16 weeks) as they generally have higher iron stores. Men also tend to have higher platelet counts and fewer antibodies – which women often produce during pregnancy – making men’s blood more suitable for platelet and plasma transfusions, which are given to patients after injury or during cancer treatment.
One likely explanation for the blood donor gender gap is that women blood donors report feeling greater levels of “warm glow” than men – the pleasurable, fuzzy feeling that comes with helping others. “There’s evidence in the blood donor context that warm glow is predictive of going to donate blood and coming back again,” says Professor Eamonn Ferguson, a psychologist at Nottingham University. Warm glow, he explains, is a “sort of oxytocin high” and blood donors who experience it strongly are apt to return to get their fix.
More generally, Professor Ferguson says, there is a lot of evidence that women are more “pro-social” than men. “They tend to score higher on pro-social traits around trusting, altruism, agreeableness, compassion: general volunteer behaviour.” Women also tend to have higher levels of oxytocin than men, and the hormone is associated with increased generosity: in randomised controlled trials involving economic games, participants administered with an oxytocin nose spray were more trusting and gave more money away than participants who were given a placebo.
How can more men be encouraged to become donors?
Figuring out what does motivate men to give blood is a key part of Nadine Eaton’s job as head of blood marketing at NHSBT. She says that while women tend to be more emotionally motivated, more driven by the desire to help others in need, men, more generally, “want to look like heroes.” The “egotistical aspect” is stronger in men’s motivations; they tend to be more curious about how giving blood will affect them, and more likely to google “health benefits of giving blood.” Many other countries see a similar gender gap in blood donors, Eaton says, citing international research that suggests men are more incentivised than women to donate by rewards, such as free coffee mugs.
As with blood donation, women respond overwhelmingly to emotional appeals to become stem cell donors, according to Rebecca Pritchard, Head of Register Development at the UK’s Anthony Nolan stem cell register. This makes recruiting men a challenge, when much of the charity’s messaging urging the public to join the register has centred on cancer patients who are in desperate need of a matching donor. But Pritchard also wonders if men may be more turned off than women by the donation process, which is usually very similar to giving blood, but in around 10 per cent of cases involves a small procedure under general anaesthetic. “At recruitment events, young men tend to be the most squeamish about needles, about procedures,” she says.
At recruitment events, young men tend to be the most squeamish about needles, about procedures.
Nowadays, would-be donors can sign up to the register with a simple cheek swab that they return in the post, but in the past, anyone wanting to join had to provide a small blood sample at a hospital or recruitment event. “It was always the men who would faint,” Pritchard recalls. “Even now, when we do school assemblies to raise awareness about donation, occasionally someone will feel unwell, and it’s generally young boys.”
The tactics being deployed to win over more male donors seem broadly similar for the blood and stem cell registers: both NHSBT and Anthony Nolan have teamed up with young male ‘influencers’ in the world of sports who are passionate about donation, and both have partnerships with predominantly male organisations – the NHS with the armed forces, and Anthony Nolan with the Scottish Fire and Rescue Service.
Starting the conversation
Organ donation is a very different story. Although slightly more women donate live kidneys than men overall, a more complicated picture emerges when you break down the figures. In what may be the most altruistic form of all donation – going through a major operation and several weeks’ recovery to give a kidney to a total stranger – the gender balance is virtually equal. The vast majority of kidney donors, however, give to a friend or family member in need, and these ‘directed’ donors are predominantly women: an average of 55 per cent over the last six years.
The fact that women still generally earn less than men, and are more likely to be stay-at-home parents, is one possible reason for this, Professor Marson points out: “Say two parents might be eligible to donate to a child, then if the father is the breadwinner, the decision might be made that it’s easier if the mother donates, so they don’t lose money.”
Living donation is a deeply personal choice, and the NHS’s campaigning is geared towards raising awareness of the Organ Donation Register, which anyone can sign to give consent for their organs to be used after death. Although women account for 53 per cent of the register, more deceased men than women actually go on to donate their organs because more men die of conditions such as brain haemorrhages and strokes in which their organs can be used.
Andi Ttofa, head of organ donation marketing at NHSBT, thinks women’s slight lead on the register is partly because women tend to be more engaged with health matters generally. Women are much more likely to discuss the issue of organ donation with someone they know – 51 per cent of women versus 43 per cent of men. But this isn’t necessarily a problem, she says. Although Ttofa wants everyone to consider joining the organ register, which counts as legal consent, someone who hasn’t signed it can still go on to donate after they die if their loved ones believe it was something they would have wanted to do – which is why discussing the issue is so important, she says. “Yes, women are more likely to watch a big piece on organ donation on a TV programme like This Morning. But if that’s going to engage women to start a conversation and talk to the men in their lives, their fathers, sons, husbands, partners, whatever – then that’s a good thing.”
That’s probably what we all need to keep doing – men, women and anyone who doesn’t fall within those categories: start the conversation.
About the contributors
Hannah Partos is a writer whose work has been published in the Guardian, the Times and the Mail on Sunday, among others. She often works with Anthony Nolan, the UK’s stem cell register and blood cancer charity. In 2016, she won Anthony Nolan’s Journalist of the Year award.
Thomas S G Farnetti
Thomas is a London-based photographer working for Wellcome. He thrives when collaborating on projects and visual stories. He hails from Italy via the North-east of England.
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